The modern approach to the nipple‐sparing mastectomy

Abstract

A modern perspective on the nipple-sparing mastectomy (NSM) looking at current indications as well as the most up-to-date evidence both in the literature and from our institution. There is an in-depth description of our NSM technique and an overview of alternative approaches, including the robotic technique. The complicated concept of the learning curve is addressed and ideas on how to train other NSM adopters. K E Y W O R D S breast cancer risk reduction, breast cancer surgery, nipple-sparing mastectomy, robotic nipple-sparing mastectomy, surgical technique

Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center

“…8,13,21 Expansion of the use of NSM has been a subject of debate; however, the oncological safety of NSM in locally more advanced tumors (stage IIB or higher) or in patients receiving neoadjuvant chemotherapy has not been sufficiently demonstrated. 22,23 Tumor-to-nipple distance is also a topic that has generated much debate. Traditionally, a tumor-to-nipple distance of 2 cm has been suggested as the limit criterion for performing NSM; however, this is not uniformly accepted in the literature.…”

“… 8 13 21 Expansion of the use of NSM has been a subject of debate; however, the oncological safety of NSM in locally more advanced tumors (stage IIB or higher) or in patients receiving neoadjuvant chemotherapy has not been sufficiently demonstrated. 22 23 …”

Current Surgical Innovations in the Treatment of Breast Cancer

“…Nipple-sparing mastectomy has also been found to be safe and effective at preventing breast cancer in high-risk populations, including patients with pathogenic BRCA mutations (40). Most surgeons will only offer nipple sparing mastectomy to women with small to moderate sized breasts with minimal ptosis to reduce the risks of flap and nipple necrosis and prevent nipple malposition (41), and to avoid this in patients with advanced disease, in whom a complication associated with nipple necrosis would delay much needed adjuvant therapy. Novel approaches to prevent this have been developed, including the surgical delay procedure in which the skin flap is created extending beyond the nipple-areolar complex and surrounding mastectomy skin by about 4-5 cm between 7-21 days prior to surgery.…”

Robot‐assisted nipple‐sparing mastectomy and immediate breast reconstruction with gel implant and latissimus dorsi muscle flap: Our initial experience

“…However, the complications associated with conventional surgery when curing breast cancer include lymphedema, fat necrosis, wound infection, limited range of motion, and arm paralysis. The oncological safety of nipple areola‐preserving skin mastectomy with immediate breast reconstruction (NSMIBR) has been proven and is considered as an acceptable surgical approach 4,5 …”

“…oncological safety of nipple areola-preserving skin mastectomy with immediate breast reconstruction (NSMIBR) has been proven and is considered as an acceptable surgical approach. 4,5 Minimally invasive surgery with concealed incisions for endoscopic NSMIBR has been widely used, but the technique has not achieved effective clinical outcomes due to the limited arm movement during the surgical field of view. Robot-assisted surgery is an advanced surgical technique which can significantly be used for performing surgical interventions in patients associated with breast, thyroid, urology, colorectal, prostate, paediatric, gastrointestinal, and gynaecological cancers.…”